Forensic analysis of latent fingermarks by silver-assisted LDI imaging MS on nonconductive surfaces

Silver-assisted laser desorption ionization (AgLDI) imaging mass spectrometry (IMS) has been demonstrated to be a useful technology for fingermark analysis allowing for the detection of several classes of endogenous as well as exogenous compounds. Ideally, in IMS analyses, the fingermarks are deposited under controlled conditions on metallized conductive target slides. However, in forensic investigations, fingermarks are often found on a variety of nonconductive surfaces. A sputtered silver layer renders the target surface conductive, which allows the analyses of insulating surfaces by time-of-flight IMS. Ultimately, the major consideration when developing analytical methods for the analysis of latent fingermarks is their capability to be incorporated within forensic standard operational procedures. To demonstrate the potential of AgLDI IMS for forensic applications, fingermarks deposited on nonconductive surfaces commonly found during an investigation, including paper, cardboard, plastic bags and lifting tape, were first revealed by the Sûreté du Québec by using forensic enhancement techniques prior to the IMS analyses. Numerous endogenous compounds including fatty acids, cholesterol, squalene, wax esters, triglycerides and several exogenous substances were detected and imaged. Here, we show that silver sputtering can provide visual enhancements of fingerprint patterns after FET procedures through different scenarios in which AgLDI IMS can contribute to forensic investigations. Copyright © 2017 John Wiley & Sons, Ltd.

Assessing the Potential of Metal-Assisted Imaging Mass Spectrometry in Cancer Research

In the last decade, imaging mass spectrometry (IMS) has been the primary tool for biomolecular imaging. While it is possible to map a wide range of biomolecules using matrix-assisted laser desorption/ionization IMS ranging from high-molecular-weight proteins to small metabolites, more often than not only the most abundant easily ionisable species are detected. To better understand complex diseases such as cancer more specific and sensitive methods need to be developed to enable the detection of lower abundance molecules but also molecules that have yet to be imaged by IMS. In recent years, a big shift has occurred in the imaging community from developing wide reaching methods to developing targeted ones which increases sensitivity through the use of more specific sample preparations. This has been primarily marked by the advent of solvent-free matrix deposition methods for polar lipids, chemical derivatization for hormones and metabolites, and the use of alternative ionization agents for neutral lipids. In this chapter, we discuss two of the latest sample preparations which exploit the use of alternative ionization agents to enable the detection of certain classes of neutral lipids along with free fatty acids by high-sensitivity IMS as demonstrated within our lab.

Validation of the Brain Symptom and Impact Questionnaire (BASIQ) to assess symptom and quality of life in brain metastases

OBJECTIVE

To validate the Brain Symptom and Impact Questionnaire (BASIQ) version 1.0 for brain metastases.

METHODS

Patients with brain metastases and their healthcare professionals (HCPs) assessed the relevance of the BASIQ on a 0-10 scale with 10 as extremely relevant.

RESULTS

A total of 52 patients and 20 HCPs participated in this study. In total, 95% of HCPs and 85% of patients found all items relevant. Balance and walking ability were rated relevant by 100% of patients and HCPs. Headache, nausea, energy, memory and ability to do housework were also rated relevant by 100% of HCPs. Over 95% of patients determined the items of ability to do housework, tiredness, energy, vision, memory and putting ideas into words as relevant. There were no items rated below 7 by patients or below 5 by HCPs.

CONCLUSION

This study indicates that BASIQ version 1.0 has valid content items encompassing disease-related symptom and impact on daily living.

Aprepitant and granisetron for the prophylaxis of radiotherapy-induced nausea and vomiting after moderately emetogenic radiotherapy for bone metastases: a prospective pilot study

PURPOSE

We evaluated the novel combination of aprepitant and granisetron for the prophylaxis of radiotherapy-induced nausea and vomiting (rinv) among patients receiving moderately-emetogenic radiotherapy for thoracolumbar bone metastases.

METHODS

In this single-centre two-arm nonrandomized prospective pilot study, patients undergoing single-fraction radiotherapy (8 Gy) received aprepitant 125 mg and granisetron 2 mg on the day of radiotherapy and aprepitant 80 mg on each of the first 2 days after the day of radiotherapy. Patients undergoing multiple-fraction radiotherapy (20 Gy in 5 fractions) received aprepitant 125 mg on day 1 of radiotherapy, aprepitant 80 mg on days 3 and 5 of radiotherapy, and granisetron 2 mg on every day of radiotherapy. Symptoms and total medication intake were recorded daily during the acute phase (day 1 of radiotherapy until the first day after the last day of radiotherapy), and the delayed phase (days 2-10 after the last day of radiotherapy). Control of vomiting, retching, and nausea was defined as no symptoms and no use of rescue medication.

RESULTS

Control rates for single-fraction patients (n = 13) were 100% for acute nausea, 62% for delayed nausea, 100% for acute vomiting and retching, and 85% for delayed vomiting and retching. Control rates for multiple-fraction patients (n = 6) were 67% for acute nausea, 83% for delayed nausea, 67% for acute vomiting and retching, and 83% for delayed vomiting and retching. No grade 3 or 4 toxicities attributable to the study intervention were observed.

CONCLUSIONS

The combination of aprepitant and granisetron was safe and efficacious for the prophylaxis of rinv after both single- and multiple-fraction moderately emetogenic radiotherapy for thoracolumbar bone metastases. Our results require confirmation in a larger population.

The utilization of telephone follow-up in the advanced cancer population: a review of the literature

BACKGROUND

Palliative cancer patients often require clinic or hospital follow-up after any treatment intervention they may have received. This is typically done in person at either a hospital or a clinic. In these advanced cancer patients, this may be burdensome and result in attrition. Telephone follow-up is becoming more frequently used as an adjunct to clinical follow-up. It can be conducted for both clinical trials, as well as interventional purposes. The purpose of this study was to review the literature and examine the utility and effectiveness of telephone follow-up in the advanced cancer population.

METHODS

A literature search was conducted on Medline (1980 - April week 4 2012), Embase (1980 - week 17 2012), the Cochrane Central Register of Controlled Trials (April 2012) and CINAHL (1981-July 31 2012).

RESULTS

A total of 11 studies were identified that were published between 2001 and 2011. All studies were in the clinical trial setting. Studies that utilized telephone follow-up in the advanced cancer population, as well as studies that compared the feasibility of telephone follow-up with hospital follow-up, were included in this review. Follow-up at week 4 (month 1) was the most common interval for patient contact. Information collected during the contact varied with the study; however, the most commonly used tool was the Edmonton Symptom Assessment System. Other information included analgesic diary, patient feedback, satisfaction with the care and post-treatment side effects, along with a variety of quality of life questionnaires. Some studies provided information to the patient about protocols for care, advice and coping strategies. Attrition was common even with the use of telephone contact in place of clinical follow-up.

CONCLUSION

Telephone follow-up is a feasible alternative to traditional hospital follow-ups for assessment of symptom palliation. There are fewer burdens on the patient, allowing for a better maintenance of quality of life and lower rates of attrition in clinical trials. Patients had an overall positive opinion of the use of this alternative approach with no common disadvantages. A combination of follow-up strategies, such as clinic follow-up and telephone contact for those not attending, may result in a more comprehensive assessment.

Patterns of practice in the prescription of palliative radiotherapy for the treatment of bone metastases at the Rapid Response Radiotherapy Program between 2005 and 2012

OBJECTIVE

We examined whether patterns of practice in the prescription of palliative radiation therapy for bone metastases had changed over time in the Rapid Response Radiotherapy Program (rrrp).

METHODS

After reviewing data from August 1, 2005, to April 30, 2012, we analyzed patient demographics, diseases, organizational factors, and possible reasons for the prescription of various radiotherapy fractionation schedules. The chi-square test was used to detect differences in proportions between unordered categorical variables. Univariate logistic regression analysis and the simple Fisher exact test were also used to determine the factors most significant to choice of dose-fractionation schedule.

RESULTS

During the study period, 2549 courses of radiation therapy were prescribed. In 65% of cases, a single fraction of radiation therapy was prescribed, and in 35% of cases, multiple fractions were prescribed. A single fraction of radiation therapy was more frequently prescribed when patients were older, had a prior history of radiation, or had a prostate primary, and when the radiation oncologist had qualified before 1990.

CONCLUSIONS

For patients with bone metastasis, a single fraction of radiation therapy was prescribed with significantly greater frequency.

Minimal clinically important differences in the Edmonton symptom assessment system in patients with advanced cancer

CONTEXT

Longitudinal symptom monitoring is important in the setting of patients with advanced cancer. Scores over time may naturally fluctuate, although a patient may feel the same.

OBJECTIVES

The purpose of this study was to determine the minimal levels of change required to be clinically relevant (minimal clinically important difference [MCID]) using the Edmonton Symptom Assessment System (ESAS).

METHODS

Between 1999 and 2009, patients completed the ESAS before palliative radiotherapy and at follow-up. MCIDs were calculated using both the anchor- and distribution-based methods for improvement and deterioration; 95% confidence intervals for the differences in mean change scores between adjacent categories also were calculated.

RESULTS

A total of 276 patients completed the ESAS at baseline and during at least one follow-up visit. At the four-week follow-up, decrease of 1.2 and 1.1 units in pain and depression scales, respectively, constituted clinically relevant improvement, whereas increase of at least 1.4, 1.8, 1.1, 1.1, and 1.4 units, respectively, in pain, tiredness, depression, anxiety, and appetite loss items were required for deterioration. At the subsequent follow-ups, these values were similar. Overall, the MCID for improvement tended to be smaller than that for deterioration. The distribution-based method estimates tended to be larger than the 0.3 SD estimates, but closer to the 0.5 SD estimates.

CONCLUSION

MCIDs allow health care professionals to determine the success of treatment in improving the patient's quality of life. MCIDs may prompt health care professionals to intervene with new treatment. Future studies should confirm our findings with a variety of anchors.

Continued success in providing timely palliative radiation therapy at the Rapid Response Radiotherapy Program: a review of 2008-2012

OBJECTIVE

We set out to review the Rapid Response Radiotherapy Program (rrrp).

METHODS

We retrospectively reviewed a prospective database of patients referred to the rrrp between August 1, 2008, and June 30, 2012, extracting patient demographics, case dispositions, and wait times in days from referral to consultation and from consultation to treatment.

RESULTS

Of 2742 patients referred to the rrrp, 1458 (53%) were men, and 1284 (47%) were women. Median age was 64 years. The most prevalent primary cancer sites were lung (33%), breast (21%), and prostate (17%). The most common reasons for referral were bone metastases (53%) and brain metastases (21%). Palliative radiation therapy was given to 1890 patients. The median wait time from referral to consultation was 3 days. Among treated patients, 60% were treated on the day of their consultation, and 33%, within 1-6 days.

CONCLUSIONS

The rrrp continues to deliver timely palliative radiation therapy to patients, comparable to earlier reviews. The continued success of the rrrp will remain a model for future rapid-access palliative radiation therapy clinics.

Symptom clusters in patients with metastatic cancer: a literature review

This article reviews the literature reporting empirically determined symptom clusters in patients with metastatic cancer. A literature search was conducted on symptom clusters within heterogeneous metastatic cancer patient populations using MEDLINE, EMBASE, and CINAHL. Studies examining predetermined symptom clusters were excluded. A total of eight relevant studies published between 2005 and 2011 were identified. The number of symptom clusters extracted varied from two to eight clusters per study, comprising of two to eight symptoms per cluster. There were no clusters consistently identified within all eight studies. Notable differences in symptoms assessed, assessment tools, statistical analysis, patient demographics were observed between the studies. The lack of consensus among the inter-study symptom clusters are likely due to the differences in patient population as well as study methodology. Further exploration in metastatic symptom cluster research will ideally improve patient outcomes by facilitating improved symptom management in future clinical practice.

Gender differences in symptoms experienced by advanced cancer patients: a literature review

INTRODUCTION: Advanced cancer patients are multi-symptomatic and require attentive palliative care. As gender differences are apparent in multiple aspect of everyday life, this literature review aims to determine the gender differences seen in the population of advanced cancer patients and the symptoms that they experience. METHODS: A literature review was conducted using the OvidSP Medline database from 1946 to November 2012. Randomized, prospective or retrospective cohort studies on advanced cancer patients who were undergoing any type of palliative treatments (palliative radiation, chemotherapy) or those in which palliative treatments have failed (antalgic treatment) were included. The patient population, tools/questionnaire used and gender differences in symptoms found statistically or qualitatively significant in the respective studies were extracted. RESULTS: Of the 163 studies resulting from the literature search, nineteen publications were identified. Gender differences in multiple symptoms were discovered. Gender differences were commonly found in symptoms of emotional changes, fatigue, gastrointestinal symptoms (nausea, vomiting, and diarrhea) anxiety, tension, sleep problems and pain. CONCLUSION: At present, gender differences seen in the symptoms experienced by advanced cancer patients continues to be inconclusive. Further study investigating gender differences in the symptoms experienced by advanced cancer patients as the primary endpoint is recommended.

Comparison of the EORTC QLQ-BM22 and the BOMET-QOL quality of life questionnaires in patients with bone metastases

AIMS

Bone metastases are a common complication of advanced cancer and often result in a decrease in patients' quality of life. Very few specific modules have been created to accurately assess quality of life in this patient group. The purpose of this study was to compare two questionnaires, the European Organization for Research and Treatment of Cancer quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM22) and the bone metastases quality of life questionnaire (BOMET-QOL.

METHODS

A literature search was conducted in Medline, Health and Psychosocial Instruments, Embase and Embase Classic to identify studies that discussed the development, validation and reliability of the (EORTC) QLQ-BM22 and the BOMET-QOL. Studies that discussed the development and validity of the questionnaire along with studies using these tools were included.

RESULTS

Both questionnaires were developed in collaboration with patients and health-care professionals. The QLQ-BM22 is over twice the length of the BOMET-QOL, with 22 questions as compared to 10. The QLQ-BM22 has four subscales while the BOMET-QOL has no subscales. The QLQ-BM22 gives a more in-depth analysis of symptoms and well-being and includes issues such as mobility, side effects, complications of treatment and dependency. The BOMET-QOL is shorter and gives an overall assessment of pain and mobility. Scoring, item format, organization and response options vary between the questionnaires but the recall period for both is the previous week. Both questionnaires have been determined valid and reliable.

CONCLUSION

The QLQ-BM22 and the BOMET-QOL are designed specifically for patients with bone metastases and each has strengths and weaknesses. Use of one over the other is ultimately dependent on trial design and investigators' goals.

Minimal important differences in the EORTC QLQ-C30 in patients with advanced cancer

AIMS

Quality of life (QOL) is important in patients with advanced cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a general QOL tool used in cancer patients. Often, with a large enough sample, statistical significance of changecan be reached, however the clinical significance is often unknown. This study aimed to determine the magnitude of change that is meaningful to advanced cancer patients in the EORTC QLQ-C30.

METHODS

Patients completed the EORTC QLQ-C30 at baseline and 1 month post-radiation to assess changes in their QOL. Minimal important differences (MID) were calculated through anchor and distribution-based methods for improvement and deterioration. The two anchors of overall health and overall QOL were used to determine meaningful change.

RESULTS

Statistically significant meaningful changes were seen in the use of both anchors. The overall health anchor produced a greater number of scales and symptoms that reached a statistically significant meaningful change. Meaningful change for improvement with these two anchors ranged from 9.1 units (cognitive functioning) to 23.5 units (pain), and for deterioration it ranged from 7.2 units (physical functioning) to 13.5 units (role functioning). Distribution-based estimates were closest to 0.5 SD.

CONCLUSION

Knowledge of meaningful change on the EORTC QLQ-C30 allows physicians to assess patients' changes over time, along with evaluating the impact of treatment on a patient's QOL. This knowledge gives insight into whether the treatment is effective and, ultimately, whether it should be continued. Knowledge of MID may assist in the determination of sample size for future trials.

Meaningful change in oncology quality-of-life instruments: a systematic literature review

Quality of life (QoL) is increasingly being recognized as an important end point in oncology clinical trials. The purpose of this study was to review the literature on what constitutes a meaningful change in oncology QoL instruments. A literature search was conducted in Medline, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Articles determining clinically meaningful change were selected. Twenty six publications were identified. Common anchors included performance status, global rating of change and overall QoL. The distribution approach utilized standard deviations and standard error of measurement. Limitations included optimism bias and a change in patients' internal frame of reference. Currently, there is an inconsistency between meaningful change studies. Analyses should be conducted in population-specific samples, as meaningful change varies depending on patient characteristics. Consistently, meaningful change for improvement has been smaller than that for deterioration, suggesting that patients are more responsive to improvement.

Health Care Professionals’ Evaluation of Quality of Life Issues in Patients With Brain Metastases

Background

The Functional Assessment of Cancer Therapy - Brain (FACT-Br) is a brain specific Quality of life (QOL) tool used for patients in the primary and metastatic cancer population. The purpose of this report is to evaluate the QOL issues health care professionals (HCPs) find most important when caring for brain metastases patients.

Methods

HCPs were asked to rate whether each of the 23 FACT-Br subscale items were relevant to patients or not. In the survey, HCPs indicated the 5 to 10 top issues affecting the QOL of patients with brain metastases. Demographic information such as gender, years of experience, and health care specialty were recorded.

Results

A total of 46 HCPs participated in the study, 89% of HCPs ranked the need for help in caring for themselves as the most relevant item for patients with brain metastases. Other highly relevant items included the concern of getting headaches (81%) and weakness in arms or legs (78%). The lowest rated items included the ability to put thoughts together (8%), ability to write as they used to (11%) and also the ability to read as they used to (14%).

Conclusion

It is very important to determine the issues that HCPs think are most important to patients in an attempt to harmonize these with those of patients. Future studies should compare the items that HCPs rate as most relevant to those that patients rate to ensure agreeability.

Controlled outcome evaluation of the First Step Program: a daily physical activity intervention for individuals with type II diabetes

OBJECTIVE

To conduct a randomised trial of a physical activity (PA) intervention, The First Step Program (FSP) for adults with type II diabetes.

DESIGN

A 16-week intervention study and 24-week follow-up assessment.

PARTICIPANTS

A total of 47 overweight/obese, sedentary individuals (age=52.7 +/- 5.2 y; BMI=33.3 +/- 5.6 kg/m2) recruited through a diabetes education centre.

MEASUREMENTS

PRIMARY OUTCOME

daily PA assessed by pedometer (steps/day).

SECONDARY OUTCOMES

anthropometric measures (weight, BMI, waist girth, hip girth); indicators of cardiovascular health (resting heart rate and blood pressure); glycemic control (fasting glucose, insulin, HbA1c, glucose concentration 120 min postglucose load); plasma lipid status (total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides).

RESULTS

Relative to the CONTROL group, FSP participants increased their PA >3000 steps/day (approximately 30 min/day) during the intervention (P<0.0001). Waist and hip girth decreased (approximately 2-3 cm), but did not differ significantly between groups. Significant changes did not emerge for any of the other variables.

CONCLUSIONS

The FSP is a practical intervention that elicits an immediate and profound change in walking behaviour. Such change is an important 'first step' towards increasing the volume and/or intensity of PA necessary to improve long-term health outcomes in this largely sedentary and overweight or obese population. Relapse by 24 weeks indicates that other strategies such as booster sessions are needed to maintain lifestyle change. Further research must determine realistic and responsive health outcomes for this population that are achievable through practical, real-world programming.